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β受体阻滞剂在非心脏手术患者中的应用：系统评价和荟萃分析。

Beta-Blocker Use in Patients Undergoing Non-Cardiac Surgery: A Systematic Review and Meta-Analysis.

机构信息

Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito 170525, Ecuador.

Facultad de Medicina, Universidad de Carabobo, Valencia 2005, Venezuela.

出版信息

Med Sci (Basel). 2024 Nov 11;12(4):64. doi: 10.3390/medsci12040064.

DOI:10.3390/medsci12040064
PMID:39584914
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11587062/
Abstract

BACKGROUND

The use of beta-blockers in the perioperative period has been widely investigated due to their potential to reduce the risk of major adverse cardiovascular and cerebrovascular events (MACCE) and mortality; yet their overall impact on various postoperative outcomes remains debated. This study constitutes a systematic review and meta-analysis of the impact of beta-blockers on mortality, MI, stroke, and other adverse effects such as hypotension and bradycardia in patients undergoing non-cardiac surgery.

METHODS

A comprehensive systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. Searches were performed across PubMed, Cochrane, Web of Science, Scopus, EMBASE, and CINAHL databases; we included randomized controlled trials and cohort and case-control studies published from 1999 to 2024.

RESULTS

This meta-analysis included data from 28 studies encompassing 1,342,430 patients. Perioperative beta-blockers were associated with a significant increase in stroke risk (RR 1.42, 95% CI: 1.03 to 1.97, = 0.03, I = 62%). However, no statistically significant association was found between beta-blocker use and mortality (RR 0.62, 95% CI: 0.38 to 1.01, = 0.05, I = 100%). Subgroup analyses revealed a protective effect on mortality for patients with high risks, such as patients with a history of atrial fibrillation, chronic heart failure, and other arrhythmias. For myocardial infarction (RR 0.82, 95% CI: 0.53 to 1.28, = 0.36, I = 86%), a reduction in events was observed in the subgroup of randomized controlled trials. Beta-blockers significantly increased the risk of hypotension (RR 1.46, 95% CI: 1.26 to 1.70, < 0.01, I = 25%) and bradycardia (RR 2.26, 95% CI: 1.37 to 3.74, < 0.01, I = 64%).

CONCLUSIONS

Perioperative beta-blockers show increasing rates of stroke events following non-cardiac surgery but do not significantly impact the incidence of MI or mortality. The increased risks of hypotension and bradycardia necessitate careful patient selection and monitoring. Future research should aim to refine patient selection criteria and optimize perioperative management to balance the benefits and risks of beta-blocker use in surgical settings.

摘要

背景

由于β受体阻滞剂有可能降低主要不良心血管和脑血管事件（MACCE）和死亡率，因此在围手术期广泛研究了β受体阻滞剂的使用；然而，它们对各种术后结局的总体影响仍存在争议。本研究对β受体阻滞剂对非心脏手术患者的死亡率、心肌梗死（MI）、中风和其他不良反应（如低血压和心动过缓）的影响进行了系统评价和荟萃分析。

方法

根据 PRISMA 2020 指南进行全面的系统评价和荟萃分析。在 PubMed、Cochrane、Web of Science、Scopus、EMBASE 和 CINAHL 数据库中进行了检索；纳入了 1999 年至 2024 年发表的随机对照试验和队列研究及病例对照研究。

结果

该荟萃分析纳入了来自 28 项研究的 1342430 名患者的数据。围手术期使用β受体阻滞剂与中风风险增加显著相关（RR 1.42，95%CI：1.03 至 1.97， = 0.03，I = 62%）。然而，β受体阻滞剂的使用与死亡率之间无统计学显著关联（RR 0.62，95%CI：0.38 至 1.01， = 0.05，I = 100%）。亚组分析显示，对于具有高风险的患者，如具有心房颤动、慢性心力衰竭和其他心律失常病史的患者，β受体阻滞剂对死亡率有保护作用。对于心肌梗死（RR 0.82，95%CI：0.53 至 1.28， = 0.36，I = 86%），随机对照试验亚组观察到事件减少。β受体阻滞剂显著增加低血压（RR 1.46，95%CI：1.26 至 1.70， < 0.01，I = 25%）和心动过缓（RR 2.26，95%CI：1.37 至 3.74， < 0.01，I = 64%）的风险。

结论

非心脏手术后，围手术期使用β受体阻滞剂会增加中风事件的发生率，但不会显著影响心肌梗死或死亡率的发生。低血压和心动过缓的风险增加需要仔细选择患者并进行监测。未来的研究应旨在细化患者选择标准并优化围手术期管理，以平衡β受体阻滞剂在手术环境中的使用的获益和风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9f0c/11587062/a40e24869d77/medsci-12-00064-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9f0c/11587062/ebc4e5e9fa10/medsci-12-00064-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9f0c/11587062/db704ece2e50/medsci-12-00064-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9f0c/11587062/955269eb3caf/medsci-12-00064-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9f0c/11587062/a40e24869d77/medsci-12-00064-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9f0c/11587062/ebc4e5e9fa10/medsci-12-00064-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9f0c/11587062/db704ece2e50/medsci-12-00064-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9f0c/11587062/955269eb3caf/medsci-12-00064-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9f0c/11587062/a40e24869d77/medsci-12-00064-g004.jpg

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